This form contains 130 fields organized into 11 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name	Type	Description
Additional Information
Additional Information (Initial and date each notation)	Text	Enter any additional remarks or clarifications regarding reverification and rehire. Provide each separate note in this field, and immediately following each note, enter your initials and the date in MM/DD/YYYY format. Complete this field only if you have supplementary information; otherwise, leave it blank.
Second Additional Information (Initial and date each notation.)	Text	Use this second Additional Information (Initial and date each notation.) field to record any further notations when completing a second reverification or rehire. For each entry, write your initials and the date in mm/dd/yyyy format. Complete this field only if you are performing a second reverification or rehire; otherwise leave blank.
Third Additional Information (Initial and date each notation)	Text	If completing the third reverification and rehire entry, enter any additional notations here. For each notation, provide your initials followed by the notation date in MM/DD/YYYY format. Leave this field blank if you have no additional notations for the third entry.
Document Information
Reverification Document Title	Text	Enter the full title of the List A or List C document the employee presented for reverification exactly as it appears on the document (for example, U.S. Passport; Driver’s License; Employment Authorization Document (Form I-766); Social Security Card). Complete this field only when filling out the Reverification section for an employee who requires reverification. No special formatting is required.
Document Number (if any)	Text	Enter the identifying number exactly as it appears on the document you provided in the “Document Title” field. Include all letters, numbers, hyphens, and spaces. If the document has no number, leave this field blank.
Document Expiration Date (if any)	Text	Enter the expiration date of the document you listed under Document Title and Document Number (if any). If the document has an expiration date, enter it in MM/DD/YYYY format. Leave this field blank if the document does not expire.
First List A Document Title	Text	Enter the exact title of the first document you are providing from List A for identity and employment authorization (for example, “U.S. Passport,” “Permanent Resident Card,” or “Employment Authorization Document”). This field is required when you present a List A document. Enter the document title exactly as it appears on the document.
Second Reverification Document Number (if any)	Text	Enter the identifying number exactly as it appears on the document you entered in Document Title for the second reverification entry. Only complete this field if the employee presents a document for a second reverification of continued employment authorization. Include all letters, numbers, and hyphens in the exact sequence shown on the document. Leave blank if the document does not have a number.
Expiration Date (if any) (mm/dd/yyyy) of Second Document for Reverification	Text	Enter the expiration date of the document you listed under Document Title and Document Number (if any) in the second Reverification section. Use the format mm/dd/yyyy. If the document has no expiration date, leave this field blank.
Third Document Title	Text	Enter the exact title of the List A or List C document the employee presented for the third reverification and rehire. Only complete this field when filling out the third set of document entries in the Reverification and Rehire section. Type the document’s title exactly as it appears on the original document (for example, “U.S. Passport” or “Form I-766, Employment Authorization Document”).
Third Reverification Document Number (if any)	Text	Enter the identification number exactly as it appears on the document you listed in "Document Title" for the third reverification entry. If the document does not include a number, leave this field blank.
Third Reverification Document Expiration Date	Text	Enter the expiration date (if any) of the document recorded in Document Title and Document Number (if any) under Reverification (third set). Format as MM/DD/YYYY. If the document has no expiration date, leave this field blank.
Employee Attestation
A citizen of the United States	CheckBox	Check this box to attest that you are a citizen of the United States when completing your employment eligibility verification.
A noncitizen national of the United States (See Instructions.)	CheckBox	Check this box if you are a noncitizen national of the United States and are attesting to your immigration status for employment eligibility verification.
A lawful permanent resident (Enter USCIS or A-Number.)	CheckBox	Check this box if you are a lawful permanent resident of the United States and enter your USCIS or Alien Registration Number to attest your employment authorization.
USCIS A-Number	Text	Enter your USCIS A-Number exactly as shown on your Permanent Resident Card (Form I-551), beginning with “A” followed by eight or nine digits. Do not include spaces or hyphens. Only complete this field if you checked the box labeled “3. A lawful permanent resident (Enter USCIS or A-Number.)”
A noncitizen (other than Item Numbers 2 and 3 above) authorized to work until (exp. date, if any)	CheckBox	Check this box if the employee is not a U.S. citizen, noncitizen national, or lawful permanent resident but holds valid authorization to work in the U.S. that expires on a specified date.
Work Authorization Expiration Date	Text	Enter the expiration date of your work authorization as shown on your employment authorization document in MM/DD/YYYY format. Required only if you checked “4. A noncitizen (other than Item Numbers 2. and 3. above) authorized to work until (exp. date, if any)”; otherwise, leave blank.
USCIS A-Number	Text	Enter your USCIS Alien Registration Number (A-Number), including the leading “A” followed by all digits, without spaces or hyphens. Complete this field only if you checked the box labeled “A noncitizen (other than Item Numbers 2. and 3. above) authorized to work until (exp. date, if any)” in Section 1. Otherwise, leave this field blank. Max length: 10 characters
Form I-94 Admission Number	Text	Enter the Admission Number from your most recent Form I-94 Arrival/Departure Record. Only complete this field if you checked the checkbox for Item Number 4, “A noncitizen (other than Item Numbers 2. and 3.) authorized to work until (exp. date, if any),” and you elect to provide the I-94 Admission Number instead of a USCIS A-Number or passport. Copy all letters and numbers exactly as shown; do not include spaces or hyphens. Max length: 11 characters
Foreign Passport Number and Country of Issuance	Text	Enter the number of your unexpired foreign passport and the country that issued it. Complete this field only if you have selected the checkbox labeled "4. A noncitizen (other than Item Numbers 2. and 3. above) authorized to work until (exp. date, if any)". Format as PassportNumber, CountryName (for example, "123456789, Canada").
Employee Signature	Text	Type or sign your full legal name as your signature exactly as it appears on your official documents. Required: Complete and sign Section 1 of Form I-9 no later than your first day of employment. Do not enter the date here; use the Today's Date (mm/dd/yyyy) field to the right.
Today's Date	Text	Enter the date you complete and sign Section 1 of Form I-9 in MM/DD/YYYY format. This field is required.
Employee Information
Last Name (Family Name)	Text	Enter your family name (surname) exactly as it appears on your official identity document (e.g., passport or driver’s license). This field is required. Do not include prefixes, suffixes, or punctuation.
First Name (Given Name)	Text	Enter the employee’s first or given name exactly as it appears on official documents (e.g., passport or birth certificate). Required for Section 1. Employee Information and Attestation; must be completed no later than the first day of employment. Use only alphabetic characters; include hyphens or apostrophes if part of your name; do not enter initials, abbreviations, numbers, or symbols.
Middle Initial (if any)	Text	Enter your middle initial as a single alphabetic character. If you do not have a middle name or initial, leave this field blank. Max length: 1 characters
Other Last Names Used (if any)	Text	Enter any other last names you have used (for example, maiden name, married name, or any legal name changes). If you have used more than one, separate each name with a comma (e.g., “Smith, Johnson”). Leave this field blank if you have not used any other last names.
Street Number and Name	Text	Enter the street number and full street name of your primary residence (for example, 1234 Main St). This field is required. Use numeric street numbers and standard street-type abbreviations (e.g., St, Ave, Blvd).
Apartment Number (if any)	Text	Enter the apartment, unit, or suite number for your street address (as provided in Address (Street Number and Name)). Leave blank if you do not have an apartment or unit number.
City or Town	Text	Enter the full name of the city or town where you reside, matching the location in the “Address (Street Number and Name)” field. Use standard spelling and do not use abbreviations (for example, enter “Los Angeles,” not “LA”). This field is required.
State	ComboBox	Enter the two-letter U.S. Postal Service abbreviation for the State, territory, or district where you reside. Use uppercase letters (for example, CA for California or NY for New York). This field is required. AK AL AR AS AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MI MN MO MP MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR RI SC SD TN TX UT VA VI VT WA WI WV WY CAN MEX
ZIP Code	Text	Enter the five-digit ZIP Code for the employee's address. If known, include the four-digit ZIP+4 extension separated by a hyphen (e.g., 12345-6789). This field is required. Max length: 6 characters
Date of Birth (MM/DD/YYYY)	Text	Enter the employee’s date of birth as two digits for the month, two digits for the day, and four digits for the year (MM/DD/YYYY). This field is required in Section 1. Employee Information and Attestation.
U.S. Social Security Number	Text	Enter your nine-digit Social Security Number (SSN) as issued by the U.S. Social Security Administration. Required. Type all nine digits without spaces or hyphens (e.g., 123456789). Max length: 9 characters
Employee’s Email Address	Text	Enter your personal email address in a valid format (e.g., [email protected]). Complete this field when filling out Section 1: Employee Information and Attestation of Form I-9, no later than your first day of employment.
Employee's Telephone Number	Text	Enter the telephone number where you can be reached. Use a standard U.S. 10-digit format with area code, such as (123) 456-7890 or 123-456-7890.
First Name (Given Name) from Section 1	Text	Enter the employee’s first name (given name) exactly as entered in the “First Name (Given Name) from Section 1” field of Form I-9 Section 1. This field is required when completing Supplement A. Match the spelling, capitalization, hyphens, and spaces exactly as originally provided; do not add prefixes, suffixes, or extra characters.
Middle Initial (if any) from Section 1	Text	Enter the employee’s middle initial exactly as provided in Section 1 of Form I-9, using a single alphabet character. Leave this field blank if the employee did not list a middle initial.
Second New Name - Last Name (Family Name)	Text	Enter the employee's current legal last name in the "New Name (if applicable)" section for the second rehire or reverification event. Only complete this field if you are completing a second rehire or reverification within three years of the date the original Form I-9 was completed. Use the exact spelling as it appears on the employee's supporting documentation.
Second New First Name (Given Name)	Text	In the second “New Name (if applicable)” section, enter the employee’s current legal first (given) name exactly as shown on their legal documents. Complete this field only if you have provided a second “Date of Rehire (if applicable)” entry; otherwise leave it blank. Use only alphabetic characters and do not include punctuation.
New Middle Initial (Second Rehire)	Text	In the second “New Name (if applicable)” section for Rehire, enter the employee’s new middle initial. Only complete this field if the employee is being rehired a second time and their new name includes a middle initial; otherwise leave it blank. Enter exactly one alphabetic character (A–Z). Max length: 1 characters
Third New Last Name (Family Name)	Text	If this is a third rehire and the employee’s legal name has changed, enter the employee’s current family name exactly as shown on their updated documents under “New Name (if applicable).” Use alphabetic characters and hyphens only; do not include generational suffixes. Leave blank if not applicable.
Third New First Name (Given Name)	Text	Enter the employee’s new first name (given name) exactly as it appears on their legal documentation in the third “Date of Rehire (if applicable) / New Name (if applicable)” section. Only complete this field if you are using this third rehire or name-change section; otherwise leave it blank.
Third New Name (if applicable) Middle Initial	Text	Enter the single uppercase middle initial (one letter A–Z) of your new legal name for the third rehire under "New Name (if applicable)". If you have no middle initial or are not providing a new name for this rehire, leave this field blank. Max length: 1 characters
Employer Information
Name of Employer or Authorized Representative	Text	Enter the full printed name of the employer or authorized representative completing this Supplement B. Include given name, middle initial (if any), and family name. Required when completing Supplement B for reverification or rehire. The individual named here must also sign in the “Signature of Employer or Authorized Representative” field.
Signature of Employer or Authorized Representative	Text	Enter the handwritten signature of the person whose name appears in the “Name of Employer or Authorized Representative” field. Sign using ink within this box. Required after completing the Reverification and Rehire (Supplement B) section and on or before the date entered in “Today's Date (mm/dd/yyyy)”.
Today's Date (mm/dd/yyyy)	Text	Enter the date on which the Employer or Authorized Representative signs the form under 'Signature of Employer or Authorized Representative'. Use mm/dd/yyyy format.
Second Employer or Authorized Representative Name	Text	Enter the full legal name (first name, middle initial if any, and last name) of the employer or authorized representative who completes the second Reverification and Rehire attestation. Complete this field only if you are using the second “Reverification and Rehire (formerly Section 3)” section; otherwise leave it blank.
Second Signature of Employer or Authorized Representative	Text	Enter the employer’s or authorized representative’s handwritten signature for the second rehire or reverification entry in Supplement B, Reverification and Rehire. Only complete this field when documenting a second instance of rehire or reverification. Sign your full name in ink exactly as you would on legal documents.
Today's Date (mm/dd/yyyy)	Text	Enter the date in MM/DD/YYYY format on which the Employer or Authorized Representative signs the “Signature of Employer or Authorized Representative” field. This date is required when completing that signature.
Name of Employer or Authorized Representative (third rehire)	Text	Enter the full printed name (Family Name, Given Name, Middle Initial) of the Employer or Authorized Representative who is attesting to this third rehire or reverification entry on Supplement B. Complete this field only when you are filling out the third rehire section.
Signature of Employer or Authorized Representative (third Reverification and Rehire entry)	Text	In ink, enter the handwritten signature of the employer or authorized representative in the Signature of Employer or Authorized Representative field for the third Reverification and Rehire entry on Supplement B (Form I-9). Only complete this field if you are entering a third rehire or reverification; leave blank if not applicable.
Today's Date for Third Reverification or Rehire	Text	Enter the date you sign the “Signature of Employer or Authorized Representative” field for the third reverification or rehire in mm/dd/yyyy format. Required when completing this reverification/rehire section.
Employer Review and Verification
Document Title (List A)	Text	Enter the exact title of the List A document you examined, as it appears on the document (for example, “U.S. Passport,” “Permanent Resident Card,” or “Employment Authorization Document”). Complete this field only if you are documenting with a List A document; if you are using List B and List C documents instead, leave this field blank. No additional formatting is required.
Issuing Authority for First List A Document	Text	Enter the full name of the government agency or authority that issued the document you entered in "Document Title 1" under List A. Required when you provide a document title in "Document Title 1". Use the exact issuing name as it appears on the document (for example, U.S. Department of State).
First List A Document Number (if any)	Text	Enter the document number or identifier from the first document listed in “Document Title 1” under “List A.” Copy all letters, numbers, and symbols (such as hyphens) exactly as they appear on the document. Leave this field blank if the document has no number.
First List A Document Expiration Date (if any)	Text	Enter the expiration date of the document you entered in Document Title 1 under List A, if it has an expiration date. Format as mm/dd/yyyy. If the document does not have an expiration date, leave this field blank.
Second List A Document Title (if any)	Text	Enter the exact title of the second document presented under List A in Section 2 (for example, “Form I-94 Admission Number”). Complete this field only if a second List A document was presented; otherwise leave blank.
Issuing Authority for Second List A Document	Text	Enter the full official name of the authority that issued the document you entered in “Document Title 2” under List A. Complete this field only if you have provided a second List A document. Use the exact wording as it appears on the document (no abbreviations).
Second List A Document Number (if any)	Text	Enter the identification number exactly as it appears on the second document you listed under “Document Title 2 (if any)” in List A. Only complete this field if you provided a List A document in “Document Title 2 (if any)” and filled in “Issuing Authority”; otherwise leave it blank. Include all letters, numbers, hyphens, or spaces exactly as printed on the document.
Expiration Date of Second List A Document (if any)	Text	Enter the expiration date of the second List A document you recorded in Document Title 2. Provide the date in MM/DD/YYYY format. Complete this field only if you entered a Document Title 2 and that document carries an expiration date; otherwise, leave it blank.
Third List A Document Title (if any)	Text	Enter the official title of the third document presented from List A to establish both identity and employment authorization. Only complete this field if the employee provided a third List A document. Type the document title exactly as it appears on the supporting document (for example, U.S. Passport, Employment Authorization Document).
Issuing Authority for List A Document 3	Text	Enter the full official name of the agency or authority that issued the document you listed in “Document Title 3 (if any).” Required only if you entered a value in “Document Title 3 (if any)”; otherwise leave this field blank. Use the formal name (for example, “U.S. Department of State,” “Government of Canada”).
Third List A Document Number (if any)	Text	Enter the number exactly as printed on the third document you presented in “Document Title 3 (if any)” under List A. Complete this field only if you provided a third List A document; otherwise leave it blank. Include any letters, numbers, or symbols exactly as they appear on the document.
Expiration Date (if any) for Document Title 3	Text	Enter the expiration date of the document you listed under “Document Title 3 (if any)” in List A. Use MM/DD/YYYY format. Only complete this field if that document has an expiration date; leave blank if it does not expire or if you did not use a third document.
List B Document Title	Text	Enter the exact title of the identity document the employee presented from List B in Section 2 of Form I-9, as it appears on the document (for example, “Driver’s License” or “State ID Card”). Required if the employee provides a List B document; otherwise leave this field blank.
Issuing Authority for First List B Document	Text	Enter the full official name of the agency or authority that issued the document you listed under “Document Title” in List B. Complete this field only when you record a document in List B of Section 2. Use the exact name as it appears on the document; do not abbreviate.
List B Document Number (if any)	Text	Enter the document number exactly as it appears on the identity document you provided under List B in Section 2: Employer Review and Verification. Include all letters, numbers, and hyphens. If the document does not contain a number, leave this field blank.
List B Document Expiration Date (if any)	Text	Enter the expiration date of the List B identity document provided in Section 2. Use the exact date printed on the document in MM/DD/YYYY format. If the document does not expire, enter “N/A.”
First List C Document Title	Text	Enter the full title of the first List C document you are presenting for employment authorization in Section 2. Copy the title exactly as it appears on the document (for example, “Social Security Account Number Card”). This field is required if you are providing only List C documentation instead of a List A or List B document.
Issuing Authority for First List C Document	Text	Enter the full name of the authority (agency or issuer) that issued the first List C document you entered in Document Title 1. Required when completing List C in Section 2. Provide the name exactly as it appears on the document, without abbreviations.
List C Document Number	Text	Enter the identification number from the List C document you provided to establish employment authorization under the heading “List C.” Required when you complete the List C section by first filling in Document Title 1 and Issuing Authority. Type the number exactly as it appears on your document, including any letters or hyphens; if the document does not contain a number, enter “N/A.”
List C Document 1 Expiration Date	Text	Enter the expiration date of the List C document you entered under “Document Title 1” in Section 2. Use the format mm/dd/yyyy. If the document has no expiration date, leave this field blank.
Additional Information (Section 2)	Text	Enter any additional documentation details or free-form remarks related to the employee’s Form I-9 verification in Section 2. Complete this field only if you have supplementary documents to record (for List A, List B, or List C) or if you used an alternative procedure authorized by DHS to examine documents ("Check here if you used an alternative procedure authorized by DHS to examine documents."). Leave blank if not applicable. No special formatting is required.
Check here if you used an alternative procedure authorized by DHS to examine documents	CheckBox	Select this box when the employer has used a DHS-approved alternative procedure rather than a direct physical examination to verify the employee’s identity and work authorization documents.
First Day of Employment	Text	Enter the employee’s actual first day of employment in MM/DD/YYYY format (e.g., 07/15/2023). This field is required.
Name and Title of Employer or Authorized Representative	Text	Enter the full last name (family name), first name (given name), and official job title of the employer or authorized representative who examined the employee’s documents and is signing Section 2: Employer Review and Verification. This field is required and must be completed no later than three business days after the employee’s first day of employment.
Signature of Employer or Authorized Representative	Text	Enter the employer’s or authorized representative’s signature in the space provided. This is required after completing Section 2, Employer Review and Verification, and must be signed within three business days after the employee’s first day of employment.
Today's Date (mm/dd/yyyy)	Text	Enter the date on which you, as the employer or authorized representative, signed the "Signature of Employer or Authorized Representative" field in Section 2: Employer Review and Verification. Use mm/dd/yyyy format. This field is required.
Employer’s Business or Organization Name	Text	Enter the full legal name of the employer’s business or organization exactly as it appears on state or federal registration. This field is required to complete Section 2 of Form I-9 after examining the employee’s documents. Include all punctuation and corporate designators (e.g., “Inc.,” “LLC”) only if they are part of the official registered name.
Employer’s Business or Organization Address (City, State, ZIP Code)	Text	Enter the full street address of the employer’s business or organization, including: street number and name (plus suite or unit number if applicable), city or town, two-letter USPS state abbreviation, and 5-digit ZIP code (or ZIP+4 in the format #####-####). This field is required.
Preparer and/or Translator Certification
Employee Last Name from Section 1	Text	Enter the employee’s last name (family name) exactly as it appears in Section 1 of Form I-9. This field is required when completing Supplement A as a preparer or translator.
Preparer/Translator Certification
Signature of Preparer or Translator	Text	Enter your full handwritten signature as the preparer or translator who assisted the employee in completing Section 1 of USCIS Form I-9. Use black or blue ink and sign within the signature block. This field is required whenever you have assisted in Section 1.
Date of Preparer or Translator Signature	Text	Enter the date the preparer or translator signed the certification in MM/DD/YYYY format. Required if completing the “Signature of Preparer or Translator” field.
Preparer or Translator’s Last Name (Family Name)	Text	Enter the last name (family name) of the preparer or translator who assisted in completing Section 1 of Form I-9 Supplement A. This field is required when a preparer or translator completes Section 1. Use the full family name exactly as it appears on official identification; do not enter initials, abbreviations, prefixes (e.g., “Dr.”), or suffixes.
Preparer or Translator First Name (Given Name)	Text	Enter the full given (first) name of the preparer or translator who is completing Supplement A for Section 1 of Form I-9. This field is required when you are certifying that you assisted in Section 1. Do not use initials or abbreviations.
Preparer or Translator Middle Initial (if any)	Text	Enter the middle initial of the preparer or translator who completed the Preparer and/or Translator Certification for Section 1. Use exactly one uppercase alphabetic character. If the preparer or translator has no middle name, leave this field blank. Max length: 1 characters
Preparer or Translator Street Address	Text	Enter the preparer or translator’s street number and name (include apartment, suite, or unit number if applicable). Complete this field only if you have signed in “Signature of Preparer or Translator”; otherwise leave blank. Provide the full street address as free-form text without additional formatting constraints.
First Preparer or Translator City or Town	Text	Enter the name of the city or town where the first preparer or translator’s address is located. This field is required when completing the Preparer and/or Translator Certification for Section 1 of Form I-9. Provide only the city or town name; do not include state or ZIP Code.
Preparer’s State	ComboBox	Enter the two-letter U.S. Postal Service abbreviation for the state of the preparer’s mailing address. Required when completing the Preparer and/or Translator Certification for Section 1. Use two uppercase letters (e.g., CA for California). AK AL AR AS AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MI MN MO MP MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR RI SC SD TN TX UT VA VI VT WA WI WV WY CAN MEX
Preparer or Translator ZIP Code	Text	Enter the U.S. postal ZIP code for the Preparer or Translator’s mailing address in the Preparer and/or Translator Certification for Section 1. Provide five digits (e.g., 12345) or ZIP+4 (e.g., 12345-6789) if known. This field is required when completing the Preparer and/or Translator Certification for Section 1 of Form I-9. Max length: 6 characters
Signature of Second Preparer or Translator	Text	If a second preparer or translator assisted in completing Section 1 of Form I-9 Supplement A, enter your full hand-written signature in this field. This field is optional and should be completed only by the additional preparer or translator. Use black or blue ink on paper or an equivalent electronic signature when filling online.
Translator Certification Date (mm/dd/yyyy)	Text	If you are completing the Translator Certification area under “Preparer and/or Translator Certification for Section 1,” enter the date you sign the “Signature of Preparer or Translator” field here in mm/dd/yyyy format. Leave blank if not applicable.
First Preparer or Translator Last Name (Family Name)	Text	Enter the last name (family name) of the first preparer or translator signing the Preparer and/or Translator Certification for Section 1 of Form I-9. Required if you assisted the employee in completing Section 1 of Form I-9. Type or print your full surname exactly as you want it to appear; do not use initials or abbreviations.
Second Preparer or Translator Last Name (Family Name)	Text	Enter the family name (surname) of the second preparer or translator who assisted in completing Section 1 of Form I-9. Required only if you completed a separate second certification; otherwise leave this field blank. Do not include prefixes (Mr., Ms.) or suffixes (Jr., Sr.).
Second Preparer or Translator Middle Initial (if any)	Text	Enter one uppercase letter: the middle initial of the preparer or translator who signs in the second “Signature of Preparer or Translator” certification area under Supplement A. If that individual has no middle name, leave this field blank. Max length: 1 characters
Second Preparer or Translator Address (Street Number and Name)	Text	Enter the street number and name of the second preparer or translator’s address (for example, “123 Main St”). Only complete this field if a second preparer or translator assisted with completing Section 1; otherwise leave it blank.
City or Town (Second Preparer or Translator)	Text	Enter the full name of the city or town where the second preparer or translator signed and dated in the “Signature of Preparer or Translator” certification area of Supplement A. Required only if you completed the second preparer or translator section; leave blank if not applicable.
Second Preparer or Translator State	ComboBox	Enter the two-letter U.S. Postal Service abbreviation (e.g., CA, NY) for the state corresponding to the “Address (Street Number and Name)” and “City or Town” entries in the second Preparer and/or Translator Certification for Section 1. Only complete this field if a second preparer or translator assisted in completing Section 1. AK AL AR AS AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MI MN MO MP MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR RI SC SD TN TX UT VA VI VT WA WI WV WY CAN MEX
ZIP Code (Second Preparer/Translator Certification)	Text	Enter the ZIP code for the preparer or translator who signed in the second “Signature of Preparer or Translator” section. Required if that certification section is completed. Provide a five-digit ZIP code or ZIP+4 (e.g., 12345 or 12345-6789). Max length: 6 characters
Signature of Preparer or Translator (Third Certification)	Text	Enter your full signature in ink exactly as you normally sign. Only complete this field if you are providing the third Preparer and/or Translator Certification for Section 1 in Supplement A, Preparer and/or Translator Certification for Section 1.
Third Preparer or Translator Certification Date	Text	Enter the date that you, as the third preparer or translator assisting with Section 1, signed the certification under penalty of perjury in the “Date (mm/dd/yyyy)” field next to “Signature of Preparer or Translator.” Only complete this field if you are providing a third certification. Use MM/DD/YYYY format.
Third Preparer or Translator Last Name (Family Name)	Text	Enter the family name (last name) of the third preparer or translator who assisted in completing Section 1 of Form I-9 Supplement A. Complete this field only if a third individual provided preparer/translator assistance; otherwise leave it blank. Use the full legal last name without abbreviations.
Third Preparer or Translator First Name (Given Name)	Text	Enter the given name (First Name) of the third preparer or translator who signed under “Signature of Preparer or Translator” in this Supplement A certification for Section 1. Only complete this field if a third individual assisted in completing Section 1. Use alphabetic characters only, matching the official spelling; do not include punctuation.
Third Preparer or Translator Middle Initial (if any)	Text	Enter the preparer’s or translator’s middle initial (one alphabetic character) in the third Preparer and/or Translator Certification for Section 1. This field is optional—leave blank if the preparer or translator has no middle initial. Do not include periods or other punctuation. Max length: 1 characters
Third Preparer or Translator Address (Street Number and Name)	Text	Enter the full street number and street name for the third Preparer and/or Translator Certification for Section 1. Provide the numeric house or building number followed by the street name (for example, “1234 Elm Street”). This field is required when completing the third Preparer and/or Translator Certification.
City or Town (third Preparer/Translator)	Text	Enter the full city or town name for the third Preparer and/or Translator Certification for Section 1. This field is required if you are completing a third Preparer and/or Translator Certification entry. Use the full city or town name (no abbreviations).
Third Preparer or Translator State	ComboBox	Enter the two-letter U.S. Postal Service abbreviation for the state or territory where the preparer or translator signed in the third “Signature of Preparer or Translator” certification area. Required only if a third preparer or translator assisted in completing Section 1; otherwise leave blank. Use two uppercase letters (e.g., CA). AK AL AR AS AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MI MN MO MP MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR RI SC SD TN TX UT VA VI VT WA WI WV WY CAN MEX
Third Preparer or Translator ZIP Code	Text	Enter the ZIP Code for the third preparer or translator’s mailing address as entered in Address (Street Number and Name), City or Town, and State. Use the five-digit format or ZIP+4 format (e.g., 12345 or 12345-6789). Max length: 6 characters
Signature of Preparer or Translator (Fourth Certification)	Text	Provide your full handwritten signature as the preparer or translator in the fourth certification area for Section 1 of Form I-9 Supplement A. Complete this field only if you are the fourth individual who assisted in completing Section 1; otherwise, leave it blank.
Fourth Preparer or Translator Certification Date	Text	Enter the date in MM/DD/YYYY format when you signed the "Signature of Preparer or Translator" field in the fourth certification area. Use two digits for month and day and four digits for year (for example, 07/31/2023). If you did not complete a fourth certification area, leave this field blank.
Fourth Preparer or Translator Last Name (Family Name)	Text	Enter the family name (last name) of the fourth preparer or translator who assisted in completing Section 1 of Form I-9. Complete this field only if you are the fourth preparer or translator; otherwise leave it blank.
Fourth Preparer or Translator First Name (Given Name)	Text	Enter the first name (given name) of the fourth preparer or translator who assisted in completing Section 1 of Form I-9 and signed under “Signature of Preparer or Translator” in Supplement A. Complete this field only if a fourth preparer or translator provided certification; otherwise leave it blank. Enter the full given name exactly as it appears, including any hyphens, spaces, or apostrophes.
Fourth Preparer or Translator Middle Initial (if any)	Text	Enter the middle initial (one letter) of the fourth preparer or translator completing Supplement A, Preparer and/or Translator Certification for Section 1. This field is optional — provide a single alphabet character only, and leave blank if the preparer or translator does not have a middle name. Max length: 1 characters
Fourth Preparer or Translator Address (Street Number and Name)	Text	Enter the street number and name of the preparer or translator for the fourth certification in Supplement A, Preparer and/or Translator Certification for Section 1. Provide the numeric street number followed by the street name (for example, 123 Main St). This field is required.
City or Town (fourth Preparer or Translator)	Text	Enter the full city or town name of the fourth Preparer or Translator’s address. Complete only if a fourth Preparer or Translator assisted in completing Section 1. Do not abbreviate.
Third Preparer/Translator State	ComboBox	Enter the two-letter, uppercase U.S. Postal Service abbreviation for the state where the third Preparer and/or Translator’s address is located. Complete this field only if you are filling out the third Preparer and/or Translator Certification for Section 1 in Supplement A. AK AL AR AS AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MI MN MO MP MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR RI SC SD TN TX UT VA VI VT WA WI WV WY CAN MEX
ZIP Code of fifth preparer or translator	Text	Enter the five-digit ZIP Code corresponding to the Address (Street Number and Name) provided by the fifth preparer or translator under Supplement A, Preparer and/or Translator Certification for Section 1. Use exactly five numeric digits (e.g., 12345). Complete this field only when submitting a fifth preparer or translator certification. Max length: 6 characters
Rehire Information
Second Date of Rehire (if applicable)	Text	Enter the date on which the employee was rehired for the second time, in MM/DD/YYYY format. Only complete this field when using a new section for a subsequent rehire; leave blank if not applicable.
Date of Second Rehire (mm/dd/yyyy)	Text	Enter the date on which the employee was rehired for the second time in MM/DD/YYYY format. Complete this field only if the employee has a second rehire; otherwise leave it blank.
Reverification and Rehire
Last Name (Family Name) from Section 1	Text	Enter the employee’s family name exactly as provided in Section 1 of Form I-9; use the same spelling and characters.
First Name (Given Name) from Section 1	Text	Enter the employee’s first name (given name) exactly as recorded in Section 1 of Form I-9. Fill this field only when completing Supplement B for a rehire within three years of the original Form I-9, an employee reverification, or a legal name change. Do not include middle initials, prefixes, or suffixes.
Middle Initial (from Section 1)	Text	Enter the single-letter middle initial you entered in the “Middle initial (if any) from Section 1” field of the original Form I-9. If you did not provide a middle initial in Section 1, leave this field blank. Use one uppercase letter without punctuation.
Date of Rehire	Text	Enter the employee’s rehire date in mm/dd/yyyy format. Complete this field only if the employee is rehired or reverified within three years of the original Form I-9 completion; otherwise leave it blank. Use two digits for month and day and four digits for year (e.g., 07/31/2024).
New Last Name (Family Name)	Text	Enter the employee’s new legal family name exactly as it appears on their legal name-change documentation. Complete this field only if the employee has legally changed their last name since the date on the original Form I-9.
New First Name (Given Name)	Text	Enter the employee’s full new legal first name (given name) exactly as shown on the documentation presented for rehire or reverification. Complete this field only if the employee’s name has changed since the date of the original Form I-9; otherwise leave it blank. Do not use initials or abbreviations.
New Middle Initial (if applicable)	Text	Enter the employee’s new legal middle initial exactly as it appears on supporting documentation. Use a single capital letter. Only complete this field if the employee’s name has changed; otherwise leave it blank. Max length: 1 characters
Verification Method
Check here if you used an alternative procedure authorized by DHS to examine documents	CheckBox	Check this box when you have employed an alternative procedure authorized by DHS to review and verify the employee’s documentation instead of the standard physical examination.
Check here if you used an alternative procedure authorized by DHS to examine documents	CheckBox	Select this box when you have used an alternative procedure authorized by DHS to examine the employee’s documents instead of the standard review process.
Check here if you used an alternative procedure authorized by DHS to examine documents	CheckBox	Select this box when you have used a DHS-authorized alternative procedure to review and verify the employee’s identity and work authorization documents.

Form I-9, Employment Eligibility Verification Instructions